Lesions of the Larger Vessels Following Renal Artery Constriction *

Goldblatt3 has described the visceral arteriolar necroses and hemorrhages occurring in association with hypertension and azotemia after constriction of the renal arteries in dogs. In rabbits with induced hypertension, Wilson and Pickering8 have found similar lesions. These authors have mentioned the presence of an occasional intramural hemorrhage in the smaller vessels. In a series of dogs, prepared after the same fashion in this laboratory, these observations have been confirmed, and numerous hemorrhagic lesions of the larger vessels also have been noted. This paper will describe the latter lesions and include a few examples of similar change encountered in a preliminary survey of materials from patients whose clinical story suggested such a possibility. A series of young, healthy dogs was subjected to various procedures designed to reduce blood flow through the kidneys. Blood pressures were followed by means of an adaptation of the Friedman oscillometer 2' 7and non-protein nitrogen determinations were made on the blood. The material upon which this paper is based was obtained from a group of animals surviving renal artery constriction for from three to eight days, and which showed, postoperatively, marked hypertension and progressive nitrogen retention. At autopsy a varying number of gross vascular lesions were consistently present, as were the visceral hemorrhages described by Goldblatt. The most constant site of the former was the main trunk of the pulmonary artery. The aortic arch and its branches and the thoracic aorta frequently showed numerous lesions. In the great veins hemorrhages occurred most frequently in the proximal portions of the superior and inferior venae cavae. Extensive subendocardial and myocardial hemorrhages were present, especially in the left ventricle3 as were also more minute focal hemorrhages of the valve leaflets. Grossly, the vascular lesions from the adventitial side appeared